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PED453304-193 Texas Children's Hospital (Terminated)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
Texas Children's Hospital The Woodlands - Women's Clinic -The Woodlands
Type
Children's Hospital
Rural
No
340B ID
PED453304-193
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/29/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/26/2020
Last Recertification Date
9/4/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Texas Children's Hospital
Weldon Gage, Executive Vice President/CFO
(832) 826-8084
Primary Contact
Texas Children's Hospital
Rosa I Lopez, Assistant Director , Pharmacy Financial Operations
(832) 824-1692
Addresses
Street Address
17350 St. Luke's Way
Suite 300
The Woodlands, TX 77384
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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